Long-Term Changes and Disparities in the Global Burden of Rheumatic Heart Disease Between 1990 and 2021: An Analysis Based on the Global Burden of Disease (GBD) Study

Mohammad Sadegh Talebi  Kahdouei; Hosein  Ghasempour; Fatemeh  Aghaei; Elahe  Vafaei; Behnaz  Sohrabi; Ehsan Aghaei  Moghadam; Negin  Rahimidanesh; Ali  Dahmardeh Ei; Mojataba  Shurmij

doi:10.18502/jthc.v21i1.21283

Mohammad Sadegh Talebi Kahdouei Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Hosein Ghasempour Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Fatemeh Aghaei Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Elahe Vafaei Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Behnaz Sohrabi School of Medicine, Isfahan University of Medical Science, Isfahan, Iran.
Ehsan Aghaei Moghadam Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Negin Rahimidanesh School of Medicine, Islamic Azad University, Tehran Medical Branch, Tehran, Iran.
Ali Dahmardeh Ei Department of General Surgery, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran.
Mojataba Shurmij Department of General Surgery, Shariati Hospital, Tehran University of Medical Science, Tehran, Iran.

DOI: https://doi.org/10.18502/jthc.v21i1.21283

Keywords: Rheumatic Heart Disease; Global Burden of Disease; Age-Standardized Rate; Disability-Adjusted Life Years; Years of Life Lost; Years Lived with Disability; Sociodemographic Index

Abstract

Background: Rheumatic heart disease (RHD) remains a major cause of preventable cardiovascular morbidity and mortality, particularly in low- and middle-income countries. Despite the World Health Organization’s 2018 resolution calling for the global elimination of RHD, substantial disparities in disease burden persist across regions and levels of socioeconomic development. Although previous studies have reported global trends, a clear comparative assessment of long-term changes in both fatal and nonfatal RHD burden across sociodemographic and geographic regions remains limited. This study aimed to assess long-term changes in the global burden of RHD between 1990 and 2021, with a focus on regional and sociodemographic disparities, using the most recent estimates from the Global Burden of Disease Study 2021. We additionally assessed temporal trends across sociodemographic index (SDI) groups and GBD regions, with a focus on fatal (years of life lost [YLL]) and nonfatal (years lived with disability [YLD]) components of disease burden.

Methods: We conducted a secondary analysis of model-based estimates from the Global Burden of Disease Study 2021 to assess the burden of RHD between 1990 and 2021. Metrics included age-standardized and all-age incidence, prevalence, mortality, YLL, YLD, and disability-adjusted life years (DALYs). Data were stratified by 5 SDI levels and 13 global regions. Estimates were produced using DisMod-MR 2.1 and CODEm and are reported as means with 95% uncertainty intervals (UIs).

Results: Globally, age-standardized mortality and DALY rates for RHD declined by 56% and 53%, respectively, from 1990 through 2021. YLL decreased by 59%, whereas YLD increased by 11%, indicating a shift toward chronic nonfatal burden. For example, the global age-standardized mortality rate decreased from 9.1 (95% uncertainty interval [UI], 8.4 to 9.8) to 4.0 (95% UI, 3.6 to 4.5) per 100,000. High- and high-middle–SDI regions achieved the greatest reductions across all indicators. In contrast, low- and low-middle–SDI regions experienced persistently high absolute deaths and DALYs, with South Asia accounting for more than 27% of global RHD deaths in 2021. Females consistently had a higher nonfatal burden (YLD) than males. Although the dataset includes the COVID-19 era, the specific impacts of the pandemic on RHD care and outcomes require further investigation. Across all SDI groups and regions, declines in DALYs were largely driven by reductions in YLL, whereas YLD remained relatively stable.

Conclusions: Although global RHD mortality declined, substantial regional and socioeconomic disparities persist. The epidemiologic transition toward disability highlights the need for long-term care infrastructure, particularly for women, children, and low-SDI regions. Although based on modeled estimates, this analysis provides the best available insight into global RHD epidemiology and informs data-driven health policy and planning. Despite overall improvement, disparities remain between low- and high-SDI settings, underscoring the need for context-specific prevention and long-term management strategies.